Hyperreninemic hypoaldosteronism syndrome, plasma concentrations of interleukin-6 and outcome in critically ill patients with liver cirrhosis

Cheyron, Damien du; Bouchet, Bruno; Cauquelin, B.; Guillotin, Damien; Ramakers, Michel; Daubin, Cédric; Ballet, Jean-Jacques; Charbonneau, P.

doi:10.1007/s00134-007-0864-z

Cited by 27 publications

(21 citation statements)

References 35 publications

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“…These findings are consistent with data from a previous study by Cheyron and cols. (15), which was conducted in a population of critically ill patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…Dysfunction in aldosterone production at the zona glomerulosa was first identified in the 1980s and termed "hyperreninemic hypoaldosteronism" (HH) in the critically ill (10). Previous studies suggest that HH may be associated with increased mortality in these patients (15,19). Over the past 20 years, many studies have focused on cortisol production in septic patients, with particular emphasis on the definition of CIRCI and hydrocortisone replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

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Aldosterone secretion in patients with septic shock: a prospective study

Moraes

Friedman

Viana

et al. 2013

Arq Bras Endocrinol Metab

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Objective: To assess serum levels of the main factors that regulate the activation of the zona glomerulosa and aldosterone production in patients with septic shock, as well as their response to a high-dose (250 μg) adrenocorticotropic hormone (ACTH) stimulation test. Subjects and methods: In 27 patients with septic shock, baseline levels of aldosterone, cortisol, ACTH, renin, sodium, potassium, and lactate were measured, followed by a cortrosyn test. Results: Renin correlated with baseline aldosterone and its variation after cortrosyn stimulation. Baseline cortisol and its variation did not correlate with ACTH. Only three patients had concomitant dysfunction of aldosterone and cortisol secretion. Conclusions: Activation of the zona glomerulosa and zona fasciculata are independent.Aldosterone secretion is dependent on the integrity of the renin-angiotensin-aldosterone system, whereas cortisol secretion does not appear to depend predominantly on the hypothalamic-pituitaryadrenal axis. These results suggest that activation of the adrenal gland in critically ill patients occurs by multiple mechanisms. Arq Bras Endocrinol Metab. 2013;57(8):636-41 Keywords Aldosterone; hydrocortisone; adrenal insufficiency; septic shock RESUMO Objetivo: Avaliar os níveis séricos dos principais fatores que regulam a ativação da zona glomerulosa e a produção de aldosterona em pacientes com choque séptico, assim como sua resposta ao teste de cortrosina em alta dose (250 µg). Sujeitos e métodos: Em 27 portadores de choque séptico, foram aferidos níveis basais de aldosterona, cortisol, ACTH, renina, sódio, potássio e lactato, bem como realizado teste de cortrosina. Resultados: Renina se correlacionou com níveis basais de aldosterona e sua variação após teste de cortrosina. Cortisol basal e sua variação não se correlacionaram com ACTH. Apenas três pacientes apresentaram disfunção concomitante da secreção de aldosterona e cortisol. Conclusões: Ativação das zonas fasciculada e glomerulosa são independentes. Secreção de aldosterona é dependente da integridade do sistema renina-angiotensina-aldosterona, enquanto secreção de cortisol não parece predominantemente dependente do eixo hipotálamo-hipófise-adrenal. Esses resultados sugerem que a ativação da adrenal em pacientes críticos ocorre por múltiplos mecanismos. Arq Bras Endocrinol Metab. 2013;57(8):636-41 Descritores Aldosterona; hidrocortisona; insuficiência adrenal; choque séptico

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“…These findings are consistent with data from a previous study by Cheyron and cols. (15), which was conducted in a population of critically ill patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aldosterone secretion in patients with septic shock: a prospective study

Moraes

Friedman

Viana

et al. 2013

Arq Bras Endocrinol Metab

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“…In particular, mineralocorticoid deficiency (MD) presenting as hyperreninemic hypoaldosteronism may contribute to the increased morbidity observed in septic patients. Mineralocorticoid deficiency in these patients is associated with greater inflammatory markers, increased renal failure, prolonged ICU stays, and higher mortality rates [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with MD were significantly more likely to experience hypotension (MAP ≤60 mm Hg) during the study period. MD patients required significantly more units of blood in 48 h than non-MD patients (13 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] versus 5 [2-7], P = 0.015) and had increased crystalloid requirements (18L [14-23] versus 9L [6-10], P < 0.001). MD patients were at higher risk for AKI according to RIFLE and AKIN criteria.…”

mentioning

confidence: 99%

Mineralocorticoid Deficiency in Hemorrhagic Shock

Tolstoy¹,

Aized²,

McMonagle³

et al. 2012

Journal of Surgical Research

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Background-In the critically ill, mineralocorticoid deficiency (MD) is associated with greater disease severity, the development of acute renal insufficiency, and increased mortality. We hypothesized that severely injured trauma patients presenting with hemorrhagic shock would demonstrate a high degree of MD. We also hypothesized that MD in these patients would be associated with increased length of stay, hypotension, fluid requirements, and acute kidney injury (AKI).Materials and methods-Thirty-two trauma patients in hemorrhagic shock on admission to the trauma bay (SBP <90 mm Hg × 2) were enrolled. Blood samples were obtained on ICU admission and 8, 16, 24, and 48 hours later. Plasma aldosterone (PA) and renin (PR) were assayed by radioimmunoassay. MD was defined as a ratio of PA/PR ≤2. Demographic data, injury severity score, ICU and hospital length of stay, fluid requirements, mean arterial pressure, serum sodium, hypotension, and risk for AKI were compared for patients with and without MD.Results-At ICU admission, 48% of patients met criteria for MD. Patients with MD were significantly more likely to experience hypotension (MAP ≤60 mm Hg) during the study period. MD patients required significantly more units of blood in 48 h than non-MD patients (13 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] versus 5 [2-7], P = 0.015) and had increased crystalloid requirements (18L [14-23] versus 9L [6-10], P < 0.001). MD patients were at higher risk for AKI according to RIFLE and AKIN criteria.Conclusions-MD is a common entity in trauma patients presenting in hemorrhagic shock. Patients with MD required a more aggressive resuscitative effort, were more likely to experience hypotension, and had a higher risk of AKI than non-MD patients. Future studies are needed to fully understand the impact of MD following trauma and the potential role for hormonal replacement therapy.

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“…du Cheyron et al [20] thus postulated that hyperreninemic hypoaldosteronism may be common and may have an impact on outcome in patients with acute on chronic liver failure. The authors thus investigated the relation between the adrenal production of gluco-and mineralo-corticoids, inflammatory status and outcome in critically ill patients with liver cirrhosis.…”

Section: Endocrinology and Renal Failurementioning

confidence: 99%